The effect of apnoeic oxygenation on oxygen levels during emergency intubation

Abstract

Background: During endotracheal intubation, patient ventilation is paused until the tube is passed and anchored into the trachea. This short period of apnoea may lead to a decrease in the patient’s oxygen saturation level. The administration of oxygen using a nasal cannula during this period of apnoea has been suggested as a technique that may keep the patient oxygenated while intubation is being carried out. This is commonly referred to as apnoeic oxygenation. The purpose of this review is thus to evaluate the benefits and effects of apnoeic oxygenation on the oxygen saturations of the body during intubation. Research Question: What is the effect of apnoeic oxygenation on the oxygen levels of adults undergoing intubation in the emergency department when compared to standard care? PICO Elements: The Population (P) studied were adults undergoing intubation in the emergency department. The Intervention (I) observed was the performance of apnoeic oxygenation in Comparison (C) to using usual care, while the final desired Outcome (O) was the effect on oxygen saturations. Method: A thorough systematic literature search was conducted using several databases. Literature chosen needed to be peer-reviewed works published in English in the last ten years were chosen. To evaluate the literature, the relevant CASP tools were used. Ethical concerns were also taken into account. Results: Randomised controlled trials (RCTs), systematic reviews (SRs) and metaanalyses. Five studies were found (4 SRs and 1 RCT). Conclusion: In almost all the studies reviewed, it seems that apnoeic oxygenation improves oxygen saturations. However, in one of the studies, the authors reported no effect on oxygen saturations through apnoeic oxygenation Implications and Recommendations: The need for additional studies to determine the success of the intervention, as well as incentives to perform local studies, was noted. It is recommended that local policies be put in place by management and health care experts in the field in order for apnoeic oxygenation to be practiced in local hospitals.